At present the treatment of the acute stroke is limited to managing the consequences of the primary event and attempting secondary prevention. The routine use of agents to reverse the cause or ameliorate the effects of stroke appears to be very controversial, and the value of secondary preventative measures is still far from clear. A large number of therapeutic trials have been performed in the past with no clear advantage for any drug. However, more recent studies are helping to clarify some aspects of treatment and may suggest that the active treatment of stroke is drawing near. This chapter discusses the treatments that have been tried in acute stroke, the reasoning behind their use and their performance so far. It also looks at newer treatments which may be important in the future.